(For Office Use)

2 Year 0 L.A.C.No. Part No. Sr. No.

FORM 6 [See rules 13(1) and 26] Application for inclusion of name in electoral roll To The Electoral Registration Officer, Assembly /Parliamentary Constituency. VadgaonSheri
Space for pasting one recent passport size colour photograph (3.5 cm x 3.5 cm) Showing frontal view of full face within this box

205- Chinchwad

(Here write the Name of the Constituency in which you want to be enrolled as Voter. Specify MLA Level constituency i.e. Vidhan Sabha Constituency) Sir,

_________________

I request that my name be included in the electoral roll for the above Constituency. Particulars in support of my claim for inclusion in the electoral roll are given below :I Applicants Details
st

Name Sunil Ramakant District Pune Years : 26 Day : 1 Village/Town Months : 02 Month : November Rampur

Surname(if any) Sharma

Age as on 1 January 2013 # Date of birth, if known : Place of Birth

Sex (male/female/Others) : Male Year : 1986

District Meerut State Uttar Pradesh *Fathers Name Name Ramakant Ramlal Surname(if any) Sharma Mothers Husbands II. Particular of place of present ordinary residence (Full address): House/Door number : D 202, Stargaze Apartment, Street/Area/Locality/Mohalla/Road : Opposite Goodwill Orchid Apartment, Dhanori Road ======== Town/Village: Pune Post Office : Vishrantwadi P.O. Tehsil/Taluka/Mandal/Thane : Distirct : Pune III. Details of member(s) of applicant family already included in the current electoral roll of the Constituency (Fill below section Only if Applicable) Name Relationship with Number of the roll Serial in that part Electors Photo Identity Card applicant of the Constituency number TBZ7636472 1 Ramakant Sharma Father 11 1351 2

Aundh P.O.

Pin Code :

Form-6

IV .Declarations I hereby declare that to the best of my knowledge and belief-(i) I am a citizen of India;(ii) I am ordinarily resident at the address in given para II above since1 January 2010---(date, month, year); (iii) I have not applied for the inclusion of my name in the electoral roll for any other Constituency; (iv)* My name has not been included in the electoral roll for this or any other Assembly Constituency; Or *My name may have been included in the electoral roll for ----- (Specify Previous MLA level Constituency. Fill Only if Applicable) ---- Constituency in --(Fill Only if Applicable)---State in which I was ordinarily resident earlier at the address mentioned below and if so, I request that the same may be deleted from that electoral roll. Full address (Earlier place of ordinarily residence )------- (Fill Only if Applicable) ----------Electors photo identity card (if issued)number--(Fill Only if Applicable) --date of issue --(Fill Only if Applicable)

Place : Date:

Pune 9/11/2012

Put Your Signature Here Signature or thumb impression of Please give your mobile number/E-mail.I.D.(Optional)---9011046532/sunil.sharma@gmail.com------

(A)Note- Any person who makes a statement or declaration which is false and which he either knows or believes to be false or does not believe to be true, is punishable under section 31 of the representation of the People Act, 1950 (43 of 1950) * Strike out the inappropriate alternative.

Detail of action taken (to be filed by Electoral Registration Officer of constituency)

The application of Shri/Smt./Kumari ---------------------------------------------------------------------------------------------------for inclusion of name in the electoral roll in Form 6 has been accepted*/rejected *Detailed reasons for *acceptance [under or in pursuance of rule *18/20*/26(4) or *rejection [under or in pursuance of rule 17/20*/26(4) *]

Place Date Signature of Electoral Registration Officer (Seal of the Electoral Registration officer)

(during continuous updating after final publication of electoral roll) * Strike out the inappropriate alternative

Form-6

(This page should be thick enough so that it does not get mutilated /damaged in postal transit) (Intimation of action taken) (Section-II of the page is to be filed by Electoral Registration Officer of the Constituency to be posted to that applicant on the address as given by the applicant in Section-I) --------------------------------------------------------------------------------------------------------------------1)--------------------------------------------- (Fist Fold)----------------------------------------------------------------------------Section-I

Postage Stamp to be affixed by the Electoral Registration Authority at the time of dispatch
The application in Form 6 of ** Shri /Shrimati/Kumari ---- Sunil Ramakant Sharma ----------------------------** (Full Address) House/Door number : : D 202, Stargaze Apartment

Street/Area/Locality/Mohalla/Road : Opposite Goodwill Orchid Apartment, Dhanori Road : Town/Village : Pune : ==== ====== Post Office : Vishrantwadi P.O. Pin Code : 411015 Tehsil/Taluka/Mandal/Thane : Distirct :Pune (** To be filled by the applicant)

Aundh PO

2)--------------------------------------------- (Sesond Fold)-------------------------------------------------------------------------Section-II (a)Has been- accepted and the name of Shri/Shrimati/Kumari------------------------------------------------------------------has been registered at Serial No in Part (b) rejected for the reason---------------------------------------------------------------------------------------------------

Date :

Electoral Registration Officer (Address)-----------------------------------------------------------------

205- Chinchwad
Date:

(Receipt for application)

Received the application in Form 6 of ** Shri/Shrimati/Kumari---- Sunil Ramakant Sharma -----------------Address--- D 202, Stargaze Apartment, Opposite Goodwill Orchid Apartment, Dhanori Road, Pune, Vishrantwadi P.O., 411015 ==== -------

Aundh

Signature of the officer receiving the application on behalf of the Electoral Registration Officer (Address) ------------------------------------------(** To be filled in by the applicant) For more information visit or contact:1) Election Commission of Indias web site www.eci.nic.in 2) Chief Elctoral Officer web site www.ceo.maharashtra 3) Toll Free Tel.No. 1950

Form-6